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    <title>Aangfitge verhuizing</title>
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<body>
	<h1>
		<b>Aangifte van adresverandering</b>
	</h1>

	<table style="width:100%">
		<thead>
			<tr>
				<th colspan="3" style="text-align:left">Aangever</th>
			</tr>
		</thead>
		<tbody>
		    <tr>
			  <td colspan="3"><hr /></td>
			</tr>
			<tr>
				<td style="width:49%">Naam</td><td style="width:1%">:</td><td style="width:49%">%naam%</td>
			</tr>
			
			<tr>
				<td>Voornamen (voluit)</td><td>:</td><td>%vn%</td>
			</tr>
			<tr>
				<td>Geboortedatum</td><td>:</td><td>%dat%</td>
			</tr>
			<tr>
				<td>Geboorteplaats</td><td>:</td><td>%gpl%</td>
			</tr>
			<tr>
				<td>Telefonisch te bereiken op:</td><td>:</td><td>%tel%</td>
			</tr>
			<tr>
				<td>E-mail adres</td><td>:</td><td>%em%</td>
			</tr>
		</tbody>
		<tfoot>
			<tr></tr>
		</tfoot>
	</table>

	<table style="width:100%">
		<thead>
			<tr>
				<th colspan="3" style="text-align:left">Oud adres</th>
			</tr>
		</thead>
		<tbody>
		    <tr>
			  <td colspan="3"><hr /></td>
			</tr>
			<tr>
				<td style="width:49%">Straat/Huisnr</td><td style="width:1%">:</td><td style="width:49%">%adres%</td>
			</tr>
			
			<tr>
				<td>Postcode</td><td>:</td><td>%pc%</td>
			</tr>
			<tr>
				<td>Woonplaats</td><td>:</td><td>%wp%</td>
			</tr>
		</tbody>
		<tfoot>
			<tr></tr>
		</tfoot>
	</table>
	<table style="width:100%">
		<thead>
			<tr>
				<th colspan="3" style="text-align:left">Nieuw adres</th>
			</tr>
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		<tbody>
		    <tr>
			  <td colspan="3"><hr /></td>
			</tr>
			<tr>
				<td style="width:49%">Straat/Huisnr</td><td style="width:1%">:</td><td style="width:49%">%adres%</td>
			</tr>
			
			<tr>
				<td>Postcode</td><td>:</td><td>%pc%</td>
			</tr>
			<tr>
				<td>Woonplaats</td><td>:</td><td>%wp%</td>
			</tr>
			<tr>
				<td>Datum verhuizing</td><td>:</td><td>%dverh%</td>
			</tr>
		</tbody>
		<tfoot>
			<tr></tr>
		</tfoot>
	</table>
	<p>
	Medeverhuizers
	</p>
	<table style="width:100%">
		<thead>
			<tr>
				<th  style="width:49%; text-align:left">Naam</th><th  style="width:1%; text-align:left"></th><th  style="width:49%; text-align:left">Geboortedatum</th>
			</tr>
		</thead>
		<tbody>
		    <tr>
			  <td colspan="3"><hr /></td>
			</tr>
			<tr>
				<td style="width:49%">%nm1%</td><td style="width:1%">&nbsp;</td><td style="width:49%">%gb1%</td>
			</tr>
			
		</tbody>
		<tfoot>
			<tr></tr>
		</tfoot>
	</table>
	<p>
	Overige meerderjarige personen
	</p>
	<table style="width:100%">
		<thead>
			<tr>
				<th  style="width:49%; text-align:left">Naam</th><th  style="width:1%; text-align:left"></th><th  style="width:49%; text-align:left">Geboortedatum</th>
			</tr>
		</thead>
		<tbody>
		    <tr>
			  <td colspan="3"><hr /></td>
			</tr>
			<tr>
				<td style="width:49%">%nm1%</td><td style="width:1%">&nbsp;</td><td style="width:49%">%gb1%</td>
			</tr>
			
		</tbody>
		<tfoot>
			<tr></tr>
		</tfoot>
	</table>
	<table style="width:100%">
		<thead>
			<tr>
				<th colspan="3" style="text-align:left">Aantal personen op het nieuwe adres woonachtig na verhuizing</th>
			</tr>
		</thead>
		<tbody>
		    <tr>
			  <td colspan="3"><hr /></td>
			</tr>
			<tr>
				<td style="width:49%">Aantal</td><td style="width:1%">:</td><td style="width:49%">%adres%</td>
			</tr>
			
		</tbody>
		<tfoot>
			<tr></tr>
		</tfoot>
	</table>
	<p>
	Datum/Handtekening
	</p>

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